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ENG2021-0380 ROW PERMITRIGHT OF WAY EUC PERMIT PERMIT NUMBER City of Edmonds -0380 www.cityofedmonds.gov Description: PSE-INSTALL NEW GAS SERVICE WITH PAVEMENT CUTS ISSUED: 10/14/2021 Address: 17141 SEA LAWN DR EDMONDS WA 98026 EXPIRES: 04/14/2022 Permit Type: RIGHT OF WAY EUC Permit Subtype: STANDARD Parcel Number: 00566100000900 Isle]' NAME TYPE NAME ADDRESS PHONE APPLICANT PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353 CONTRACTOR PSE/INFRASOURCE 1660 PARK LANE, BURLINGTON WA 98233 (425)457-6353 OWNER RADLI ESTER 17141 SEALAWN DR, EDMONDS WA 98020 FEE INFORMATION DESCRIPTION AMOUNT PAID CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $0.00 ENGINEERING INSPECTION FEE $110.00 $0.00 RIGHT OF WAY STANDARD - EUC PERMIT FEE $330.00 $0.00 • REQUIREMENT TYPE NOTES TRAFFIC CONTROL Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every flagger must be trained as required by WAC 296-155-305 and must have certification verifying completion of the required training in their posession. RESTORATION Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City approved material prior to the end of the workday - No Exceptions WARRANTY The contractor is responsible for workmanship and materials for a period of one year following the final inspection and acceptance of the work. INSPECTION SCHEDULING: WWW.MYBUILDING PERMIT.COM 24 HR NOTICE REQUIRED INDEMNITY The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of granting this permit. THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW 10/14/2021 :»•>/F9:1H ]1 DATE Printed: Thursday, October 14, 2021 8:38:12 AM 1 of 2 -KRWOF WAY EUC PERMIT City of • • • •:• • 1 1 :1 www.cityofedmonds. ov/425.771.0220 CONDITIONS CONDITION TYPE Easement and/or permission from adjacent property owner is required prior to entry or work within ADJACENT PROPERTY an adjacent property. It is the owner's responsibility to repair/replace all damage of utilities or frontage improvements in DAMAGE TO FRONTAGE City right of Ways or Easements to City Standards caused by or occurring during the permitted IMPROVEMENTS project. Alert affected residents and/or businesses prior to work start. Verify clear bore crossings. ENGINEERING OTHER Restore landscape to like or better conditions. Call for required inspections as noted. ESC REQ Maintain erosion and sedimentation control per City and SWMMW standard requirements. Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on SOUND OR NOISE weekdays and 10:00am and 6:00pm on Saturdays, excluding Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120. TRAFFIC CONTROL Traffic Control per approved plan and MUTCD. All Flaggers shall be certified. All utilities shall be located prior to any excavation. New locates shall be called for if at time of UTILITY LOCATES excavation, original locates are no longer identifiable. INSPECTIONS INSPECTION MEN RESULT A-1 JOB START X-2 ENGINEERING FINAL" E-7 RESTOR LIMITS Printed: Thursday, October 14, 2021 8:38:12 AM 2 of 2 ENG2021-0380 of EDM°tios RECEIVED RIGHT OF WAY CONSTRUCTION PERMIT APPLICATION S E P 21 2021 Complete and submit this Application in accordance with the Submittal /'V . i s'0 Re Right -of -Way Requirements outlined in permit Handout E6�. CITY OF MONDS q -p DEVELOPMENT SERVICES DEPARTMENT If any field is not applicable to your project, write "N/A' instead of leaving ular1n. All fields required. Incomplete Applications will be denied. SECTION A General • Project Name 106380583 Site Address or if no site address use Property Address at NW corner of project area: 17141 Sealawn Dr Associated Permits: BLD PLN ENG X Owner and Entity Holding Franchise (if applicable) Name of Company PSE/Infrasource Franchise Ordinance No: Point of Contact Susan Sid ick Title SR Permit Specialist Address 1660 Park lane city Burlington State WA Zip 98233 Phone 425-457-6353 Email susan.sidickapse.com Contractor and Authorized Agent of Owner Name of Company (see note below) Contractor Contacts During Construction Primary Name PSE/Infrasource Susan Sidick Agent Name PSE/Infrasource Title SR Permit Specialist Title SR Permit Specialist Mobile 425-457-6353 Address 1660 Park lane Email susan.sidick@pse.com City Burlington State WA Zip 98233 Secondary Name Phone 425-457-6353 Title SR Permit Specialist Email susan.sidick@pse.com Mobile City of Edmonds Business License No: Email State License No: INFRASL871 C2 [N Contractor verifies it is currently bonded d( Contractor verifies it currently has general liability insurance NOTE: ECDC 18.6o. o2o requires that the Application be signed by a licensed and bonded contractor unless otherwise approved by the city engineer. ❑ Multifamily residential ❑ Commercial ❑ City project ❑ Single family residential subdivision ❑)Single family -other ❑ Industrial ❑ Demo and rebuild or from vacant land? ❑ Other, please specify: ❑ Utility Franchise Work associated with development (check one of the above boxes as welt ❑ Traffic Control Only (no associated development) ❑ Utility Franchise Work (no associated development) City of Edmonds ROW construction permit Application --Page 1 of 3 Updated 3/25/2021 Include an overall narrative description of the proposed work. Be specific and detailed: Describe infrastructure to be impacted, such as, poles, wires, conduit, utility mains, etc. Include whether this is construction, maintenance, or repair. Include description of proposed construction methods, (e.g., bores, trenches, overhead wires proposed, depth for underground utilities, etc.) Install gas service at approx 15' W to 5' E c/I of Sealawn Dr & 495' S c/I of 171 st ST SW (1) &S paving ri it & (1) 7x7 paving a it anticipated RIGHT-OF-WAY CLOSURE AREA TOTAL DURATION (Number of Months) Sidewalk 72 hours + LF I x LF SF Alley 72 hours + LF Ix I LF SF Parking 72 hours + LF Ix I LF SF -1-2 aays SECTION B - If you are not a utility company performing work in the City ROW, skip to SECTION C. 1. The work in the right of way is on or for the following type of facilities: ❑ telecommunications ❑ cable ❑ power ❑ gas ❑ water ❑ sewer ❑ storm Details of Work to be Completed 1. Does the utility owner have existing overhead infrastructure in the area of work? Yes No x 2. Will any equipment be added underground or above ground (e.. pedestals, vaults, etc.)? If yes, describe: 3. Does the proposed work connect a lot or commercial development with utilities that serve more than one lot or commercial development? x 4. Does the work involve rebuilding or relocating an existing aboveground utility system which connects a lot or commercial development to an existingunderground common utilitystem? x 5. Does the work involve proposed additions to an aboveground utility stem? If es: x Are the additions for the purpose of serving new commercial development? x Are the additions for the purpose of serving a single-family residential subdivision? x Details of Work to be Completed Yes No 6. Does your project involve rebuilding or replacing utility equipment which currently serves more than one lot or commercial development? If yes, answer the following questions related to project area, i.e. the actual area in which the project is proposed: x 6a. Does your project involve wires/cables/lines? If yes: How many are existing? How many are to be added? City of Edmonds ROW construction permit Application --Page 2 of 3 Updated 3/25/2021 6b. Does your project involve poles? If yes: x How many poles are existing in the project area? What is the height of the existing poles? How many poles are to be removed? Are additional poles to be laced? How many? I I What is the height of the additionalpoles? 6c. Are any poles to be modified/rebuilt/replaced? If yes: x How many? I I What is the height of the poles after? Describe the modification rebuild: SECTION C Traffic Control and Public Safety. Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every flagger must be trained as required by WAC 296-155-305 and must have certification verifying completion of the required training in their possession. Restoration. Restoration shall be in accordance with City codes and Standards. All street cut trench work shall be patched with asphalt or City approved material prior to the end of the workday -NO EXCEPTIONS. Insurance. The City may require the owner or contractor to provide proof of insurance acceptable to the City prior to any permit approval. Indemnification. The Applicant agrees to defend, indemnify, and hold harmless the City of Edmonds, its officials, officers, employees, and agents against any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, including defense costs and attorney fees, resulting directly or indirectly from any act or omission of the Applicant, its subcontractors, anyone directly or indirectly employed by them, and anyone for whose acts or omissions they may be liable, arising out of, related to, or by reason of the granting of this permit; and specifically including but not limited to all loss by the failure of the Applicant to fully or adequately perform, in any respect, all authorizations or obligations under the permit. These indemnification requirements shall survive the expiration, revocation, or termination of any resulting permit approval. Acceptance of terms, conditions, and requirements. Applicant accepts the terms, conditions, and requirements set forth in this Application and agrees they apply to any resulting permit and shall comply with them to the satisfaction of the City Engineer. Applicant further agrees to comply with the conditions listed on the Submittal Requirements; with all applicable city ordinances, including but not limited to ECDC Title 18; and with all applicable requirements of state and federal law. Statement of Applicant. I declare under penalty of perjury under the laws of the State of Washington that: I am a licensed and bonded contractor; the information provided herein is correct and complete; and I am authorized by owner to act on its behalf and have authority to bind the owner to this application. Fees. The Applicant is responsible for all permit fees. APPLICANT SIGNATURE: Susan Sidick DATE: 09/09/2021 APPLICANT PRINTED NAME: Susan Sidick APPLICANT TITLE: SR Permit Specialist NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE City of Edmonds ROW construction permit Application --Page 3 of 3 Updated 3/25/2021 RECEIVED SEP 21 2021 Job #: Date: Jurisdiction: ROW Permit: Est. Start Date: Est. Duration: Puget Sound Energy Gas Pre -Inspect Form 106380583 9/1 /21 Edmonds Yes 11 /15/21 1-112 Days (12 hours) CITY OF EDMONDS DEVELOPMENT Address: 17141 SEALAWN DR SERVICES DEPARTMENT City / Zip: EDMONDS, 98026 Customer: TAD HELKE 206-396-3866 PM / Inspector: kevin Williams 425-691-7573 Job Description / Scope of Work From 2" PE main run new complete 1-1/8 PE service to SFH(36' scat stub with 67' scat ext) set New Construction: No 425 meter OR @ Inches Construction Method SCHEDULE ALL INSPECTIONS THROUGH MYBUILDINGPERMIT.COM All Scat / Trenchless PLAT Map: 159.069 171st ST SW OWNER/CONTRACTOR RESPONSIBLE FOR LOCATING � cif' �v ALL ON SITE UTILITIES. RELOCATION/REVISION TO ANY UTILITIES MAY REQUIRE A SEPERATE PERMIT. �♦ '� 0 �, 9 I ♦ Utility patches shall be combined and fL. r�� ♦ ♦ ♦ i width overlay will be required dependinc seal -a O� 50 of disturbance. Where utility patches fa .00 one travel lane, the overlay shall extend centerline of roadway. Where utility pat both travel lanes then a full width overla ,• �-°�', , �p9 �p9 � a^, „ 17131 �� 1-118PE ' ' ' .00 . 00 G 00 00 Fire Hydrar t ' Suet 425 17141 17151 5/8" r.nPE ` 1997 Applicant shall repair/replace all ENGINEERING DIVISION damage to utilities or frontage APPROVED AS NOTED improvements in City right-of-way OWNER/CONTRACTOR IS RESPONSIBLE FOR per city standards that is caused or occurs during the permitted project. Jill WJ,411.,442 10/13/2021 EROSION CONTROL AND DRAINAGE VV Work Location Size of Cut Surface Type 15' W of CL Sea Lawn DR & 495' S of CL 171st ST SW 3x5 Asphalt 5' E of CL Sea Lawn DR & 495' S of CL 171st ST SW 20 Asphalt of CL & of CL Service Information Street Information Job Type Diameter: 1-1/8" PE Flaggers #: TBD Arterial: No New Residential Svc EFV: 1-1/8" - 2600 - 9999144 Police #: No TCP: Yes Tie -In Fitting Meter: A425 Speed Limit: 25 No Parks #: TBD MDPE - 2" IPS - (DIA) 1"CTS Meter Loc: 0 Trolley Lines: Mtr Hoods #: Del Press: 6" W.C. Traffic Signal: I Bus Stop: I * Bollards: 2.5" # 1 1 4" # I ADA Ramps #:I Route #'s: II width or half I on the extent II entirely within to the ches extend into y is required. PRINT ON 11X17" SHEETS ONLY 0' 30' 60' Notes: 1. All signs and spacing to conform to the MUTCD and City of Edmonds standards. 2. All sidewalks, driveways, exits and egresses shall be completely clear unless otherwise indicated. 3. Channelizing devices are 28" traffic cones. Use traffic drums (barrels) with steady burning Type C lights on all State Routes and Hwys. 4. Sign size can be a minimum of 36" x 36" and shall not obstruct pedestrian access. 5. Crew is required to leave a minimum of 11' for traveling lane width. 6. Alert affected residents and businesses. 7. Work to take place between 9 a.m. and 4 p.m unless otherwise specified. All work for arterials and major roadways will be from 9 a.m. to 3 p.m 8. Work area will be 15' WCL of Sealawn DR & 495' SCL of 171 st ST SW. 9. If used, place NO -PARK signs 72 hours in advance of the day that the work is to be done. LEGEND ® 28" TRAFFIC CONE ® WORK PIT TRAFFIC FLOW FLAGGER WORK VEHICLE/ FLASHING LIGHTS SIGN LOCATION RIGHT OF WAY Row TEMPORARY TRAFFIC CONTROL PLAN 0�, SIGN SPACING MPH "XI. 60/65 1000, 45/55 500' 35/40 350' 30 200' 25 100, CHANNELIZATION DEVICE SPACING MPH TAPER TANGENT 55/70 40 80 30 60 E35/45 25/30 20 40 4 ZOZ/£ 6/0 6 U__Jlu1 SOUND Ai • ENERGY �J�s��ii %SONS 425-424-7316 jason.bisenius@pse.com Project Address: 17141 SEALAWN DR, EDMONDS, WA 98026. SEP 21 2021 CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT Puget Sound Energy REV Traffic ConVol Supervisor: Gregory Harwood 09/08/2,021 0 Card No. 012238 Job # Card Exp.0113112123 gregory. harwood@pse.com (425)424-6W 0 106380583 1 OF 2 PRINT ON 11X17" SHEETS ONLY 0' 30' 60' Notes: 1. All signs and spacing to conform to the MUTCD and City of Edmonds standards. 2. All sidewalks, driveways, exits and egresses shall be completely clear unless otherwise indicated. 3. Channelizing devices are 28" traffic cones. Use traffic drums (barrels) with steady burning Type C lights on all State Routes and Hwys. 4. Sign size can be a minimum of 36" x 36" and shall not obstruct pedestrian access. 5. Crew is required to leave a minimum of 11' for traveling lane width. 6. Alert affected residents and businesses. 7. Work to take place between 9 a.m. and 4 p.m unless otherwise specified. All work for arterials and major roadways will be from 9 a.m. to 3 p.m 8. Work area will be 5' ECL of Sealawn DR & 495' SCL of 171 st ST SW. 9. If used, place NO -PARK signs 72 hours in advance of the day that the work is to be done. TEMPORARY TRAFFIC CONTROL PLAN RESIDENT(S) WILL BE INFORMED OF POSSIBLE TEMPORARY DRIVEWAY CLOSURE SIGN SPACING MPH "X" 60/65 1000, 45/55 500' 35/40 350' 30 200' 25 100, CHANNELIZATION DEVICE SPACING MPH TAPER TANGENT 55/70 40 80 35/45 30 60 25/30 20 40 CREW SHALL POTHOLE FOR WATER MAIN DEPTH PRIOR TO PROJECT START ----- --------------------------------- _ b 171 ST ST SW RECEIVED CITY OF EDMONDS DEVELOPMENT SERVICES DEPARTMENT